By: Frankye Myers, DNP, Riverside Chief Nurse Executive
Ensuring that every Riverside hospital is properly staffed with Registered Nurses to meet our high standards of patient care is a crucial challenge for our health system.
As demand for nurses often outpaces supply both locally and across the country – particularly after the COVID-19 pandemic – we are implementing a creative solution: a centralized float pool of Riverside-employed nurses to serve acute care hospitals in our entire geographic area.
This strategic system will allow us to make real-time decisions to fill vacant nursing slots at any hospital, based on each day’s staffing levels and patient volumes. These rapid responses will be an important complement to pre-set shift schedules in our Emergency Departments and Medical-Surgical and Critical Care Units.
With the flexibility to quickly deploy nurses to facilities or units with the highest need, we will avoid last-minute scrambling and reduce reliance on higher cost outside agencies and/or travel nurses.
This scalable, data-driven model should greatly reduce the burden on our facility-based nurses and administrators if they are faced with unexpected staffing shortages, from Riverside Regional Medical Center (RRMC) to our smaller and more rural hospitals.
Moreover, we expect to boost overall productivity by not overstaffing some shifts while nurses in other locations may have to work overtime.
Our vision is to develop an internal pool of about 28 equivalent RNs that will go live in the late fall, before the typical winter surges of patients from December to March (and occasionally, as we all know, well into April and possibly May!).
The pool will contain three divisions: one to serve all facilities, another to focus on more rural hospitals, and a third to prioritize Riverside Shore Memorial Hospital. With a small team, Shore is vulnerable to staffing shortages during patient surges and/or on days when one or two nurses have unplanned requests to cancel a scheduled shift.
A Successful Blueprint
Joining an increasing number of hospitals across the country, RRMC has already implemented a nursing float pool for its Emergency Department. That successful initiative has helped guide the ongoing development of a system-wide program that incorporates our other hospitals.
The larger centralized float pool will be based at our Integrated Care Command Center (IC3), which has evolved over the past 18 months to act as a nerve center for the health system.
The new pool is expected to attract adaptable, experienced nurses at the middle or late stages of their careers, who are accustomed to working independently and using their critical thinking skills in different environments. In similar setups at other hospitals, pool nurses generally have at least two to three years of acute bedside experience.
Additionally, our recruiting team is confident that the greater flexibility of a float pool position will appeal to nurses who have prioritized a work-life balance, as more clinicians have done in the post-COVID years.
By lowering workplace stress and providing financial incentives to nurses willing to travel on short notice, we expect to improve retention rates and perhaps ward off early retirement by some of our best clinicians.
For nurses who remain facility- or unit-based the enhanced operational stability and predictability of a centralized labor pool should ease the anxiety and burnout risk that accompanies unexpectedly high patient volumes.
Many RNs and nurse managers have had to take on last-minute double shifts or stay overnight to cover patient care needs, which in turn leads to higher overtime costs for our hospitals.
Facility-based RNs will be able to partner with fellow Riverside team members assigned from the float pools rather than with temporary nurses from an outside entity.
As for patients, they likely will enjoy better continuity of care as we draw from one central pool of nurses, rather than calling on multiple agencies for help. The likelihood of the same RN taking multiple shifts in a week, therefore, is higher.
And while the current focus is on RNs, the same approach could one day be implemented for Licensed Practical Nurses and Certified Nursing Assistants.
Leveraging Technology
As Artificial Intelligence tools improve, so does our ability to analyze historical and seasonal trends to more precisely predict patient volumes and staffing needs at each of our hospitals.
AI can help us intelligently route RNs to a particular unit based on their credentials, competencies, preferences and past experience. Those decisions can happen in a matter of minutes, rather than in hours or even days.
Float pool nurses can view open shifts, receive alerts of last-minute shortages and claim assignments on their mobile devices. Wherever they land, they can access Electronic Medical Records with detailed health histories and treatment plans for patients under their care.
Additionally, Riverside has moved to an efficient, automatic central shift-routing system that updates as soon as an open shift is filled. Under past manual-entry programs at individual hospitals, managers have at times submitted requests for external help without knowing that another team member had already found a nurse internally.
New enterprise-level metrics built into our Epic system are turning decisions from reactive – based more on anecdotal reports and isolated events – to proactive and data-driven. These objective figures will provide actionable insights to Riverside leaders, who may adjust FTE levels and budgets accordingly in the future.
With all of these changes, we will be considering the big picture when it comes to our workforce – a perspective that only can benefit all of our individual locations.
As our region’s population ages, we are fully committed to preventing unsafe, unsustainable and taxing patient-nurse ratios despite a challenging shortage of RNs, particularly in our more rural service areas.
Moving forward, we welcome feedback and suggestions from team members at our hospitals, in order for us to continually evolve and improve.